The key symptoms of eating disorders are a life-threatening inability to self-regulate around food. Whether you can't stop from eating too much or too little, eating disorders do have a lot to do with, well, eating. They're not called eating disorders for nothing, right?
But difficulties with eating isn't the only domain in which people with eating disorders struggle--it's also emotional. A growing body of research is finding that people with eating disorders have difficulties in figuring out what other people are feeling. It's not that they don't care, or that they can't put themselves into other people's shoes. It's that they just can't figure it out. One of the major issues is a hypersensitivity to anger. That is, eating disorder patients see people as angry, even when they're not. No one really seems to know why this is, but it seems to be one of those general traits of people with EDs.
It's something I know a lot about.
I don't like social situations for any number of reasons (anxiety, etc), but I also tend to dislike them because I always feel that everyone hates me. Saying that they hate me is probably an overstatement, but I am usually very uncertain about how people feel about me. My brain tends to hone in on even the slightest hint of anger or ambivalence. I can never quite seem to tell what people think of me. On the one hand, my brain sees lots of anger. On the other hand, I often don't see much angry behavior directed towards me. Or at least not a huge amount of it.
So yeah, social situations are very confusing and difficult for me.
It's not just random social situations, either. I've often thought my mom was angry at me or yelling at me when she wasn't. She might be stressed, even if it's unrelated to me or the ED, but I interpret it as anger. And when someone is mad at me, I feel that they must hate me.
What this really means is that I feel I live in a hostile world. It's scary, and it doesn't help with my stress level. It helps to explain some of the reason I have lots of anxiety, and why I tend to isolate myself. Meeting new people means wading through even more uncertainty and feelings that someone is angry with me. Anorexia played into this by almost buffering me from these feelings.
When researchers studied how people with eating disorders respond to different facial expressions, they found some very intriguing results. In one study, researchers found that people with anorexia paid far more attention to angry faces than they did to positive faces. And the more attention you pay to something, the more important you think it is, and the more you remember it. Another study found that people with anorexia have difficulties telling the difference between sad and happy faces. And patients with higher levels of obsessive-compulsive symptoms had more difficulties in distinguishing between the faces.
It's not just happy and sad faces that people with eating disorders struggle to differentiate. Studies have found that people with eating disorders did worse at identifying emotions and correcting matching faces to different emotional states. Given the other studies' findings that eating disordered patients tend to identify angry faces better, it shows that the emotion problem is two-fold. A hard time identifying emotions means that people with eating disorders have to take a wild guess. The propensity for identifying and remembering angry faces best means that the brain is likely to fill in "anger" even when that emotion might not be there.
So for many people with anorexia, life seems like a never-ending series of dealing with angry people. It's not so much that the people around us are actually angrier (there's no evidence of that), it's just that we interpret it that way and also remember it that way.
It explains, too, how concerns raised by loved ones about weight and eating behaviors can cause such defensive and angry responses. Much of it is undoubtedly the eating disorders and fears about having to change behaviors or having the comfort of the eating disorder taken away. But some of it is also difficulty in distinguishing what loved ones are actually feeling. Concern can be misconstrued as hostility and anger, and the stage of an emotional meltdown is set.
I find reading these studies helpful because it helps me reframe social situations. Instead of leaping to conclusions that, in fact, people really do hate me, I can remind myself to wait for something more concrete than random worries. I can try to assess the situation before letting my emotions take over. I still don't like social situations, but I'm getting better at dealing with them.